The use of pyridostigmine (acetylcholinesterase inhibitor) can be a safe option to lessen the duration of postoperative ileus following colorectal surgery, a pilot study in the journal Colorectal Disease elucidated. This phase II study by Nagendra N Dudi-Venkata and researchers assessed the safety of pyridostigmine when used orally following the colorectal operation.

 A total of 15 adult patients (aged 50 to 82 years; 7 men) undergoing elective colorectal surgery or stoma reversal were included in this study. Most patients (53%) had an American Society of Anesthesiologists grade of greater than equal to 2 and the median body mass index of 24 to 35 kg/m².

Primary outcomes comprised of post-surgery complications during 30 days, adverse events, and gastrointestinal-2 - an authenticated composite outcome measure of recovery of gastrointestinal function following colorectal surgery, i.e. from surgery till the initial occurrence of stool and tolerance of solid consumption for 1 day without vomiting. Thirteen postoperative complications were recorded out of which, 7 were Clavien-Dindo (CD) 1, 5 were CD 2 and 1 was CD 3.

No direct association was observed between the use of pyridostigmine and the reported complications. Also, no patient had any overt symptoms of too much parasympathetic activity. The median gastrointestinal-2 was 2 days. Given the small sample size, larger controlled studies are required to strengthen this outcome and ascertain efficacy for the prevention of postoperative ileus, the study authors noted.